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In a retrospective study concerning the epidemiology of extended-spectrum beta-lactamase (ESBL) positive Enterobacteriaceae during 2007-2008 in the wards of the Carlo Poma hospital in Mantova, Mercurio surveillance software was used to detect alert microorganisms. Our objective was to link the epidemiological data with the type of patient and ward, and to assess the risk factors for such infections in particular nosocomial environments. The study enabled the change in the relative epidemiological data to be detected, and showed that such bacteria can be found almost throughout the hospital.

A prospective observational study was conducted during a two-year period to evaluate the prevalence of hospitalized pneumonia in six hospital units of the Bologna S.Orsola-Malpighi hospital (Italy). The selected units were: general surgery, general medicine, internal medicine, geriatrics, respiratory physiopathology and pneumology, with a total of 205 beds and around 4,800 admissions per year. Data were collected from the clinical cards and cases of pneumonia were distinguished by origin (community-acquired or hospital-acquired according to CDC definition), individual and clinical characteristics, and aetiology. The study involved 486 cases of pneumonia: 75 hospital-acquired and 411 community-acquired (84.6%). Patients affected by hospital-acquired pneumonia were older (average age 77 years) compared to community-acquired cases (74 years) and show a more homogeneous gender distribution (males: 48.0% vs 59.4%). Hospital stays (42 vs 21 days) and mortality rates (24.0% vs 11.7%) were significantly higher in hospital-acquired pneumonia. The incidence rate of nosocomial pneumonia was 7.4 per 1000 hospitalized patients and increased to 17-23 per 1000 in the pneumology and respiratory physiopathology units. Only 16.9% of cases had an aetiological diagnosis (14.1% community-acquired; 31.8% hospital-acquired); the most common isolates were S. aureus and P. aeruginosa. The hospital-acquired cases were caused by Gram-negative bacilli more often than the community-acquired cases, and infections were more frequently polymicrobial (37.5% vs 3.4%). In order to reduce morbidity and mortality due to pneumonia it is important to implement prevention measures in the community (i.e. specific vaccination campaigns), improve clinical protocols for aetiological diagnosis in hospitalised patients and increase epidemiological surveillance of hospital-acquired infections.

The San Giovanni Battista Hospital in Turin validated a tool for evaluating the quality of hospital patient records. The tool defines the essential contents of patient records, indicators and weights as well as the standard score that must be reached. A pilot study was performed in 2007 to evaluate whether this tool adequately evaluates the quality of hospital patient records in both medical and surgical wards, and whether it can do so in a standardized and repeatable manner. A random sample of 206 medical charts of patients admitted to the San Giovanni Battista Hospital in 2007 was extracted and analysed. The instrument was found to adequately evaluate hospital patient records in a standardisd and repeatable manner.

Background: Statistics on occupational accidents provided by the Italian Institute for Occupational Diseases and Accidents (INAIL, Italian acronym) include only events that occurred in workers with regular employment status., Objectives: The aim of the study was to establish a procedure in order to estimate the rate of occupational accidents in non-European-Union (non-EU) workers with irregular employment status and/or irregular immigrant status., Methods: The sources of data were the clinical records of the Emergency Department of San Bonifacio Hospital, and the population data of District 4 of Local Health Authority 20 of Verona, which was considered the catchment area of this hospital., Results: Among 419 cases of accidents occurred in the numerator of the rate. The denominator of the rate was estimated by calculating: (1) the subjects of working age resident in District 4 (= 83714); (2) the total number of non-EU workers, assuming that the percentage was similar to that in San Bonifacio Municipality (= 0.115); the number of irregular non-EU workers, assuming that the percentage was similar to that in north-eastern Italy (= 0.103). Non-EU workers with irregular employment status and/or irregular immigrant status should, according to these calculations, be 992 (= 83714 x 0.115 x 0.103). The rate--147.2 (= 146/992) occupational accidents per 1000 irregular non-EU workers--is more than twice as high as that calculated in 2004 in Italy in regular non-EU workers (approximately 65 accidents per 1000). The difference can be explained by the fact that irregular workers find employment mainly in agriculture, building and the metallurgic industry, which have a high frequency of accidents, and are more willing to accept risky work and longer work shifts., Conclusions: On the assumption that the rate of occupational accidents in the 500,000 irregular workers living in Italy in 2004 was 147.2 per 1000 (as in the catchment area of the San Bonifacio Hospital), the number of accidents would be 73,600, against the 116,000 that occurred among regular non-EU workers in 2004 according to INAIL. Official INAIL statistics on occupational accidents therefore show a considerable underestimation.

The author's experience in heath technology assessment of new methodologies for routine diagnosis at the Department of Anatomical Pathology at the Trento Hospital is presented. The workload of the department together with the annual budget trends (from 2000 to 2006) of the various costs is analysed. Budget analysis also allows evaluation of expenses relative to the introduction of new tests, which are increasingly requested in order to personalise therapy accordingly to the biological profile of individual patients. Health Technology Assessment permits in-depth analysis of the efficacy, safety, costs, benefits and feasibility in addition to providing a measurement of the contribution to improving the quality of work and life. This is an important tool in decision-making processes for pathologists, especially in consideration of the limited resources available in healthcare.

Unlabelled: Neoplastic disease therapy problems, e.g. antiblastic drugs manipulation, is developing. We suggested correlation assessment between the lasting professional workers' exposition of three city hospital and disease development. We selected 43 exposed workers; we gave a questionnaire regarding the modality of activity; then we examined this sample with a protocol including clinical examination and special tests (blood tests, ECG, audiometry and spirometry)., Results: over 55% of the workers reported aspecific complaint related to antiblastic exposure (headache, nausea, vertigo, dermatitis, alopecia, rhino-conjunctivitis, asthenia, parageusia, fauces dryness); we registered, instead, the absence of significant diseases related to antiblastic drugs exposure, because of both environmental and personal prevention, and clinical surveillance co-ordinated by occupational physician.

For the period 2002-2005 we verified and compared the data of the prevalence and resistance of Pseudomonas aeruginosa (PA) isolated in Mantova Hospital (Italy) with the data from the international database. From the first six-month period of 2004 a significant increase was found (9% vs 28.8%) in the prevalence of multi-drug resistant PA (MDR-PA). The principal wards involved were the Intensive Care Unit and the Department of Respiratory Diseases. A significant increase in resistance rates was observed for all antimicrobials tested, in particular for aztreonam, ceftazidime, ciprofloxacin, gentamycin and imipenem. The lowest dual resistance rates were observed between amikacina with piperacillin/tazobactam, while the highest were for those that included ciprofloxacin and beta-lactams (aztreonam, cefepime). In this study we confirm the importance of continuous surveillance of laboratory data and tightening local control measures for nosocomial infections in order to prevent the spread and selection of MDR-PA.

Objective: To evaluate the efficacy of a program to control nosocomial spread of methicillin-resistant Staphylococcus aureus (MRSA)., Methods: Analysis of the incidence of infection and contamination due to MRSA in patients admitted to the hospital of Cremona 6 months before and 3 years after the introduction of the guidelines (July 1997)., Results: During the 42 months of the study period, on 80705 admissions, 511 cases of MRSA contamination/infection were identified, the incidence being 0.57 cases per 100 admissions. The infection rate dropped from 0.34 (IC95%: 0.25-0.45) in the first 6 months of the study, before the introduction of guidelines, to 0.17 (IC95%: 0.14-0.20) in the following 3 years (p=0.01). Severe infection decreased from 0.18 to 0.1 per 100 admissions, with a 44% decrease (p=0.058), while mild infections diminished from 0.16 to 0.07 per 100 admissions (p=0.045). Methicillin resistance among nosocomial isolates of Staphylococcus aureus was reduced from 53 % to 35 % (p<0.0001)., Conclusions: The introduction of a program to control the nosocomial spread of MRSA proved effective in reducing both the incidence of infection and the methicillin-resistance of Staphylococcus aureus isolates. The cost effectiveness of the program seems very favourable.

The authors describe the survey that was conducted in the largest hospital in Rome. The aim was to estimate the disinfectants and chemical sterilizers employed and asses possible hazards for patients and workers arising from the use of disinfectants, together with the problem of waste disposal. The study was conducted by means of a survey form that was distributed to 39 departments/institute in the whole hospital of which 24 (61%) responded. Overall 635 charts were collected listing 886 usage procedures and 110 formulations with 40 different active ingredients. The disinfection fields of use were: skin(52.4%) environment (28.8%) and hospital equipment (20.8%) This study shows that a modern hospital should select very few disinfectants and prepare a handbook that can explain disinfectant usage procedures and concentrations. In the guidelines the problem of waste disposal and employee safety should also be considered.